Is Telehealth Giving the Independent Practice New Hope for the Future?

Independent medical practices are emerging from the chaos of the pandemic on stronger footing – thanks in no small part to telehealth.

A new report from Kareo finds that more than half the practices saw patient visits stay the same or grow in 2020, and three-quarters expect to see growth in 2021. In the meantime, the telehealth adoption rate among practices jumped from 22 percent in 2019 to 41 percent in 2020 to 80 percent at the end of that year.

While much of the growth can be attributed to the adoption of connected health platforms and tools to make up for the loss of in-person traffic, experts say these practices now have the confidence to plan a long-term telehealth strategy that combines the two. This runs counter to a long-standing line of thought that the independent practice is being swallowed up by large health systems.

“Contrary to expectations, independent practices actually ended the year on an upswing,” Kareo Founder and CEO Dan Rodrigues said in a press release accompanying the 2021 State of the Independent Practice Report. “The data revealed that a renewed focus on the needs of their patients and a rapid, nimble adoption of technology solutions is what allowed practices to maintain and even enhance their patient relationships. The most significant of these technologies was telehealth.”

Kareo surveyed more than 1,300 practices for this report, encompassing more than 50 specialties. Roughly 35 percent were single-physician practices, while 38 percent feature two to five providers and 27 percent comprised six or more providers.

According to the report, independent practices are changing the way they think about the future. In 2019, some 27 percent were looking to align with another practice or hospital, part of a troubling trend that had had some to predict the end of the small doctor’s office or clinic. Now, however, some 86 percent of practices surveyed say they have no plans to charge partnerships or merge.

“The future looks bright for independent practices and we, as a society, need them to stand strong in our communities,” the report notes. “According to a paper in the Annals of Family Medicine, not only do small, physician-owned practices ‘provide a greater level of personalization and responsiveness to patient needs, they have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates’ than larger or hospital-owned practices.”

The key to survival may very well lie in how these practices adapted to telehealth. Many were forced to try the technology – often for the first time – because of the pandemic, and helped in large part by state and federal emergency actions that improved access to and coverage of telehealth. They may also have been helped by a surge in new telemedicine and digital health products designed with the pandemic in mind, and aimed at helping practices to stay afloat.

The Kareo report suggests that small and independent care providers found that telehealth improved how they delivered care, by not only improving their interactions with their patients but reducing the office-based delays and bottlenecks that affect outcomes.

According to the report, more than 70 percent of practices surveyed list “delivering care” as their top priority – up from half of the practices surveyed in 2019. Other priorities include patient engagement, practice growth and care coordination, all of which can be improved by effective use of telehealth and mHealth tools.

Also high on that list is insurance reimbursements – 58 percent listed that as a priority this year, up from 45 percent in 2019. This highlights the challenges faced by independent practices as emergency state and federal measures come to an end and old telehealth rules come back into play. While some states have enacted new laws that continue pandemic-era telehealth coverage and access, the pressure is on other state and the federal government to enact long-term telehealth policy that helps practices keep the momentum they’ve seen.

Yet another factor is telehealth integration with in-person care, often called hybrid healthcare. As the nation moves away from the pandemic and in-person care makes its comeback, practices need to learn how to combine the best of both worlds, offering in-person care when needed or requested while making virtual care available as an option and highlighting when that platform improved convenience, reduces cost and boosts outcomes.

“The data shows that providers acknowledge that delivering quality care includes the entire spectrum of the patient visit - whether in person or remote,” the report notes. “It includes keeping their personal information secure, managing their prescriptions correctly, and providing the right diagnosis and treatment plan for better adherence and higher health outcomes, among other activities, in addition to the specific patient-provider interaction that occurs during the visit.”

To that end, almost 40 percent of practices surveyed say integrated technology solutions are vital to solving their challenges going forward, up from 33 percent in 2019 and the only initiative listed that grew over the past two years (other options included managing quality measure incentives, declining reimbursements from third-party payers, merit-based incentive payments and even a need to improve patient engagement).

Moving forward, practices participating in the Kareo survey say they want telehealth technology that improves doctor-patient communication, a key component to not only patient engagement but patient adherence, which in turn plays heavily into quality of care. Perhaps the last two years of mostly online and phone-based communications have helped these providers understand the value of interacting with patients instead of acting for them.

“Practitioners have a reinforced understanding of their role in patients’ lives and health, perhaps prompted by the pandemic, as well as an increasing recognition of the consumerization of healthcare,” the Kareo press release concludes. “As patients have assumed greater responsibility for their own healthcare costs, often due to an increased use of high deductible health plans, they have also exerted more active choice in finding providers that meet their expectations.”